London School of Hygiene & Tropical Medicine

The increase in resistant organisms coupled with a big fall in the number of new antimicrobial drugs has the potential to undermine modern health systems and lead to “an apocalyptic scenario”, says Professor Richard Smith.

The warning comes as the Chief Medical Officer launches the UK’s Antimicrobial Resistance Strategy and Action Plan, reflecting the need for a clear change in our understanding of and response to antimicrobial resistance by the public, NHS and government.

Writing in the BMJ, Prof Smith and co-author Professor Joanna Coast from the University of Birmingham say current estimates suggest that antibiotic resistance is a relatively cheap problem, but such estimates do not take account of the fact that antimicrobial medicines are integral to modern healthcare. For example, antibiotics are given as standard to patients undergoing surgery, to women delivering by caesarean section, and to those having cancer treatment.

“From cradle to grave, antimicrobials have become pivotal in safeguarding the overall health of human societies,” say the authors.

Although it is difficult to forecast the likely economic burden of resistance, they believe that even the highest current cost estimates “provide false reassurance” and this may mean that inadequate attention and resources are devoted to resolving the problem.

For example, current infection rates for patients undergoing hip replacement are 0.5-2%, so most patients recover without infection, and those who have an infection have it successfully treated. But the authors estimate that, without antibiotics, the rate of postoperative infection is 40-50% and about 30% of those with an infection will die.

While they recognise that this is a simplistic analysis, they say “we use it as an example to illustrate and provoke, to emphasise the point that infection rates and their consequences in terms of health service costs and human health may be unimaginable.”

A change in culture and action is needed to plan for a future with more antibiotic resistance, they conclude.

“Waiting for the burden to become substantial before taking action may mean waiting until it is too late. Rather than see expenditure on antimicrobial policies as a cost, we should think of it as an insurance policy against a catastrophe; albeit one which we hope will never happen.”

Publication

• R Smith, J Coast. The true cost of antimicrobial resistance. BMJ. doi: http://dx.doi.org/10.1136/bmj.f1493